Respiratory distress syndrome RDS is a serious condition where the lungs cannot provide sufficient oxygen. Neonatal RDS affects newborn babies who are born before their lungs are fully developed, a serious medical condition where a newborn baby's lungs cannot provide their body with enough oxygen.Pulmonary immaturity such as incomplete structural and functionally developed lung, high compliance of chest wall and deficiency of lung surfactant are common pathophysiological reasons of NRDS. The prevalence of NRDS in Pakistan is similar to the Western countries i.e. 1% but in India it raises to almost 12%. The pharmacotherapy of NRDS is mainly focused towards the goal of preventing oxygen deprivation and lung collapse. A number of clinical guidelines suggest different types of treatment approaches. A review of different approaches to treat the disease is the objective of the article.